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Could a Daily Multivitamin Help You Stay Sharp?

The COSMOS-MInd study show that seniors taking a daily multivitamin are more likely to stay sharp. A high-veggie diet might also help.

A common multivitamin may provide some protection against cognitive decline as we age. Findings from the COSMOS study were published last year in the journal Alzheimer’s & Dementia. This year the researchers amplified those results in the American Journal of Clinical Nutrition. The results from both publications suggest that taking a multivitamin supplement every day could help us all stay sharp.

COSMOS Study Looking at Multivitamins:

The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) has reported new data on how to stay sharp (American Journal of Clinical Nutrition, March 2024). Of the 21,442 adults who participated in the study, a smaller group of 573 volunteers completed all of the cognitive tests during the years of the study (COSMOS-Clinic). Those taking multivitamin and mineral supplementation had improved cognition and memory compared to those on placebo. The difference, though significant, was modest. They found no evidence of benefit for attention and executive function.

The researchers conducted an in-study meta-analysis between the three parts of the study that examined the cognitive effects of multivitamins and minerals. These groups, which did not overlap, included more than 5,000 volunteers. Based on the results of the meta-analysis, the investigators concluded that the benefits of a multivitamin supplement were equivalent to reducing cognitive aging by two years.

COSMOS-Mind Studied Cognitive Function:

COSMOS-Mind was part of the much larger trial called COSMOS (COcoa Supplement and Multivitamin Outcomes Study). The entire study was big, with 21,442 volunteers. Each participant took either cocoa extract (supplied by Mars Edge and providing 500 mg of cocoa flavanols) or placebo pills. In addition, every person in the study also took either a daily multivitamin (Centrum Silver) or a look-alike placebo. Results from the primary study showed that people taking cocoa extract were less likely to die from heart disease or stroke.

A Multivitamin to Help You Stay Sharp:

The 2,262 volunteers in the COSMOS-Mind secondary study also took either cocoa flavanols or placebo along with either a multivitamin or placebo (Alzheimer’s & Dementia, Sept. 14, 2022). These individuals, all at least 65 years old, took cognitive tests at the beginning of the study and during each of the next three years. Researchers gave each participant a global cognitive score that included test results for word list, story recall, oral trail-making, number span, digit ordering and verbal fluency. Reductions in the score measured cognitive decline.

Analysis of these data showed that the people taking multivitamins were more likely to stay sharp than those on placebo. Volunteers with cardiovascular conditions seemed to benefit the most. No significant difference was apparent among those taking cocoa flavanols.

Researchers point to this as the first long-term randomized controlled trial of multivitamins and cocoa flavanols for cognition. They caution, however, that scientists must do further studies to confirm these findings.

Malnutrition Following Hospitalization Led to Cognitive Decline:

Q. As a dentist, I had a colleague refer his great-aunt to me because of her extreme fear of dentists. She had been diagnosed with Alzheimer’s disease.

Following a recent surgery, she suffered a serious infection that required a prolonged hospital stay. Her great-nephew said she never “bounced back” and was diagnosed with dementia after that. She presented as disoriented and not sure of her surroundings.

Her doctor had put her on a special soft diet due to dental problems. The diet was rice water and Malt-O-Meal.

Prolonged infections deplete vitamins C, B1, and B6, and my patient’s restricted diet was contributing to the original deficiency. Along with minimally invasive prosthetic dental treatment, I placed her on 2 grams of vitamin C and a substantial multivitamin. By the time we completed the dental treatment, she was engaging and alert, paying attention to her dress, hair, and makeup. She had been suffering from scurvy, beriberi and pellagra since her hospital stay.

A. Thank you for the reminder that malnutrition can contribute to cognitive deterioration. We imagine your colleague was relieved that his great-aunt recovered so well. Patients or their family members should consider vitamin deficiencies as potential factors in mental decline. Moreover, treating your patient with high-dose multivitamin supplements seems to have made an important difference in her ability to stay sharp.

A High-Vegetable Diet Might Help You Stay Sharp:

An epidemiologic study from Cache County, Utah, hinted years ago that a diet rich in vegetables, whole grains, nuts and legumes could help slow cognitive decline (American Journal of Clinical Nutrition, online Sept 18, 2013). This study of senior citizens began in 1995 and lasted 11 years. Researchers assessed the participants’ eating habits four times during the study.

When the investigators analyzed the dietary patterns, they found that people eating a diet similar to the DASH diet (Dietary Approaches to Stop Hypertension) scored higher on a cognitive test. So did those whose diets followed a Mediterranean-style eating pattern. The differences were consistent over time, and though they were small, they were statistically significant.

What Were People Eating?

Both DASH and Mediterranean diets are heavy on vegetables and fruits and contain whole grains and legumes. The Mediterranean style diet has more fat in the form of nuts and olive oil, while the DASH diet features more low-fat dairy products. Both diets are low in red meat and contain minimal processed foods. Moreover, moderate alcohol consumption is usually included in scoring the Mediterranean diet pattern. However, since the vast majority of the Cache County seniors are Mormons, they don’t drink. On the other hand, they also don’t smoke, so neither alcohol nor tobacco use confounded the results. The investigators concluded that diets rich in whole grains, nuts and legumes seem to offer long-lasting cognitive benefits.

Are Vitamins a Waste of Time?

Occasionally, we still hear health professionals express the opinion that you don’t need to take vitamins. Instead, they insist, you just need to eat a well-balanced diet. The data from Cache County may support that contention. On the other hand, relatively few Americans seem to be following a Mediterranean eating pattern or even a DASH diet. Instead of a plate full of whole grains, vegetables and legumes, some of us are happier with a cheeseburger or a bucket of fried chicken. Perhaps a multivitamin can help overcome the nutritional disadvantages of the standard American diet, at least in part.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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  • Baker LD et al, "Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial." Alzheimer’s & Dementia, Sept. 14, 2022. https://doi.org/10.1002/alz.12767
  • Vyas CM et al, "Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS." American Journal of Clinical Nutrition, March 2024. DOI: 10.1016/j.ajcnut.2023.12.011
  • Wengreen H et al, "Prospective study of Dietary Approaches to Stop Hypertension– and Mediterranean-style dietary patterns and age-related cognitive change: the Cache County Study on Memory, Health and Aging." American Journal of Clinical Nutrition, online Sept 18, 2013. https://doi.org/10.3945/ajcn.112.051276
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